Brovana: A better COPD medicine

A relatively new medicine on the market that is slowly gaining acceptance by the medical community is aformoterol (Brovana).  The medicine is quickly gaining acceptance by the medical community to the benefit of the many patients with chronic obstructive pulmonary disease (COPD).

There are four reasons why Brovana is gaining acceptance

1.  It's fast acting beta adrenergic (SABA) like albuterol (Ventolin).

2.  It's long acting beta adrenergic (LABA) like Salmeterol (Serevent), a medicine in the common inhaler Advair

3.  It's only available as a solution, and must be taken using a nebulizer.

4.  The nebulizer route allows better airway distribution in patients with airflow limitation as compared with the Advair inhaler.

5.  It can be taken with Pulmicort to get the same medicinal benefits as Advair.

6.  Both Brovana and Pulmicort only need to be taken twice a day, once in the morning and once in the evening.

7.  Ventolin can still be prescribed for as needed use between doses of Brovana.

Brovana equal to Ventolin as a quick relief inhalant

Brovana (aformoterol) is best known as the only long acting beta adrenergic (LABA) available as a solution to be taken with a nebulizer. Better yet, evidence suggests it is equally effective as Ventolin as a rescue medicine.

A 2011 study by Das et al studied the efficacy and tolerability of both nebulized Ventolin and Brovana as a rescue medicines on 50 chronic obstructive pulmonary disease (COPD) patients in the acute care setting. (1)

The researchers concluded:

Our study has shown that both salbutamol and arformoterol are equally effective as a reliever medication as nebulizing solution in acute non-severe asthma. Improvement in PEFR was demonstrated in both the groups and following each dose of the drugs. The absolute increase in the PEFR after the first and the second dose were more with arformoterol than with salbutamol, but the increase in the PEFR after the third dose was similar with these two drugs. (1)

The researchers further explains why it is rapid acting when salbutamol, that active ingredient in Advair, is not:

Relatively, hydrophilic drugs such as salbutamol have a rapid onset of action due to their ability to reach the β2 receptor from the aqueous phase. Formoterol is a moderately lipophilic drug, about 300 times more than salbutamol. The aqueous portion rapidly activates the β2 receptor, whereas the lipophilic portion is taken up into the cell membrane from which it diffuses slowly to stimulate β2 receptor over a prolonged period. This accounts for rapid on set along with long duration of action of formoterol. Our study has also proved that arformoterol has a rapid onset of action. (1)

Many COPD experts now prescribe Brovana for twice a day, with Ventolin or Xopenex as needed in between.  Tiotropium Bromide (Spiriva) may also be prescribed for once a day use in combination with Brovana. (2)

References:

1. Das, Sibes K., Indranil Biswas, Arun K. Brandyopadhyay, Tapan D. Bairagya, and Somnath Bhattacharva, "A comparative study of efficacy and safety of aformoterol an salbutamol nebulization as rescue therapy in acute non severe asthma," Indian Journal of Pharmacology, 2011, July-August, 43 (4), pages 463-465
2. King, Paul T, "Review: Pharmacotherapy of Chronic Obstructive Pulmonary Disease: Focus on Aformoterol Tartrate," Clinical Medicine: Therapeutics, 2009:1, pages 1321-1327, study copy write by Libertas Academia